不同經營特性洗腎機構之洗腎服務滿意度

Patient Satisfactions of Hemodialysis Care in Different Operation-Type Health Care Organizations

蔡文正(Wen-Chen Tsai) ； 龔佩珍(Pei-Tseng Kung) ； 徐約翰(Yueh-Han Hsu) ； 廖凱平(Kai-Ping Liao)

《醫務管理期刊》 5卷1期 (2004/03) Pp. 101-119

https://doi.org/10.6174/JHM2004.5(1).101

摘要

全民健保制度下，洗腎醫療服務競爭激烈，不同層級醫院是否存在著不同之洗腎服務滿意度？目的：藉由分析洗腎病患對於治療過程與結果之滿意度以及其認為影響洗腎品質的重要因素，以瞭解在當前健保支付制度下洗腎民眾所感受之洗腎品質。方法：使用結構式問卷，經由訪員對進行洗腎過程中之患者實行一對一的問卷訪查。以台中縣市與彰化市之洗腎機構進行分層級隨機抽樣，樣本涵蓋中部地區共12家各層級醫院和4家洗腎診所，共收得708份有效問卷。結果：在滿意度與重要性方面皆以醫師、護理人員態度與護理人員技術為最高。不同醫療層級中以區域醫院、地區醫院與基層診所洗腎病患滿意度較高，其中又以基層診所較醫院為佳；公立醫院在部分服務方面較私立醫院為佳，但整體滿意度無顯著差異；經營型態方面在部分服務方面外包較自營為佳。顯著影響洗腎病患整體滿意的因素包含性別、治療效果、護士技術、護士態度、環境舒適與清潔、醫師醫術、洗腎外其他設備、提供餐點、交通時間等因素。結論：洗腎病患在現行健保制度下，對於洗腎醫療機構之服務，平均而言達到非常滿意之程度，但是仍存在著服務品質缺口，其中以「停車方便性」、「治療效果」及「醫師醫術」的落差最大，而且不同醫療層級、權屬別、經營型態之病患對洗腎滿意度不同。

關鍵字

洗腎 ； 血液透析 ； 洗腎品質 ； 病患滿意度 ； 醫療品質

並列摘要

Under the National Health Insurance program, hemodialysis services are highly competitive. Whether the different levels of health service organizations have the same quality of the hemodialysis services? Objective: This study examined the patient satisfaction of hemodialysis services and the associated factors that affected hemodialysis service satisfaction. Method: Twelve hospitals and four clinics were randomly selected from three cities in central Taiwan. Total 708 hemodialysis patients were interviewed to answer the structured questionnaires. ANOVA and multiple regression method were applied for the analyses. Results: Physician service attitude, nurse service attitude and nurse’s skill are the three most important and most satisfactory for the hemodialysis patients. Among four-level health care organizations, regional hospitals, district hospitals, and clinics have higher patient satisfaction than medical-center hospitals; especially those clinics' patients have more satisfaction than those of hospitals. Hemodialysis patients in public-ownership hospitals have higher satisfaction than private hospitals in some services but there is no significant difference for hemodialysis services as a whole. Hospitals with contracted-operation hemodialysis services have higher patient satisfaction than self-operation hospitals at some services. The factors that influence the patient satisfaction for hemodialysis services include patient sex, treatment effectiveness, nurse's skill, nurse service attitude, facility environment, physician competence, equipment other than for hemodialysis, refreshment, and transportation time. Conclusion: In general, hemodialysis patients were satisfied with hemodialysis services, but there were still some gaps of service quality between patient's expectance and real hemodialysis services, among which parking problem, treatment effectiveness, and physician competence had the biggest gaps. There were significant differences in patient satisfaction for hemodialysis services for the health service organizations with different level, ownership, or operational type.

並列關鍵字

Hemodialysis ； Quality of Hemodialysis ； Patent Satisfaction ； Health Care Quality

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